Electrical injuries: neurologic complications

Dr. Evans of Baylor College of Medicine received honorariums from Allergan, Amgen, Avanir, DepoMed, Lilly, and Novartis for speaking engagements and honorariums from Alder and Promius for advisory board membership.

)Originally released August 1, 2006; last updated July 13, 2018; expires July 13, 2021

This article includes discussion of neurologic complications of electrical injuries, including those due to electric shock and electrocution. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Electrical injury can affect any organ. Neurologic complications are well recognized and cause a distinct increase in morbidity. The broad range of neurologic complications of electrical injuries such as peripheral neuropathy, central nervous system disorders, and seizures are described. Clinical features that are useful in evaluating patients after electrical injury are identified. Neurologic sequelae of electrical injuries may present years after electrocution. Neuropsychological disorders may present as posttraumatic stress disorder. Neurologic manifestations of lightning strikes are considered in the differential diagnosis. Finally, the management of late neurologic sequelae of electrical injury is described.

Key points

• Neurologic sequelae from electrical trauma can be immediate (transient or permanent), delayed and progressive, or linked to a secondary injury caused by electrocution.

• There is an increase in the incidence of neuropsychiatric sequelae of electrical injury, such as posttraumatic stress disorder, and they are now the second most common type of sequelae after those directly related to burns.

• The diagnostic approach to the neurologic consequences of an electrical injury patient is like the neurologic evaluation of a multi-trauma injury patient.

• Indications for hospital admission are: exposure to an electrical source of more than 200 V and 200 mA; cardiac findings; loss of consciousness; fall from a height; thermal injury to greater than 15% of the body surface area or burn to the hands, feet, face, or groin; respiratory distress; spine fractures; serum electrolyte derangements; and compartment syndromes.

Historical note and terminology

History of electricity is relevant to discussion of electrical injuries. The phenomenon of static electricity by rubbing was described several hundred years before Christ. Electricity was further studied in the 17th and 18th centuries, and Benjamin Franklin was the first to point out the relation of lightning to electricity in 1752. Currently, electrical injury is 1 of the mechanisms involved in lightning injury. The first recorded case of electrical injury after the discovery of the electrical phenomenon occurred in 1746 when 2 Dutchmen were injured by the accidental discharge of a Leyden jar. Electric motors were invented in the 19th century and with the development of power stations and electrical lightning, electricity entered the industry and daily life of people. Although commercial electricity has been used in the United States since the late 19th century, most of the earliest knowledge of electrical injury was based on anecdotal reports. Scientific characterization of human response to electricity did not start until the last half of the 20th century and was documented in a special report (Dalziel 1956). Injuries from exposure to electricity may be superficial, resulting in skin burns if no electrical current travels through the body. Nevertheless, a patient who presents initially with electrical burns and no neurologic signs may develop late neurologic sequelae. In true electrical injuries, the victim becomes part of the electrical circuit with an entrance and exit site for the current. This can involve damage to various organs including the nervous system, which will be the theme of this article. Secondary injuries may be due to falls caused by contact with electrical energy. Lightning may also involve passage of electric current through the body.

Most of the electrical injuries occur in workers dealing with electric machinery or power lines. The incidence has decreased with regulation of electrical safety standards at work. Medical procedures involving exposure of the human body to electricity, particularly the brain, may result in injury. Electrical injuries can occur at home due to mishaps in handling electric appliances.

Fatal electrical shock is referred to as electrocution. The earliest electrocution in an occupational fatality dates to 1879 in a theater, whereas intentional electrical fatality as a form of capital punishment dates to the first electric chair execution in 1890 (Wilbourn 1995).

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